MEDICARE: BROADWAY FAMILY CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH00033920	WA

General Provider Information

NPI Number	:	1770664187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY FAMILY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	PO BOX 1215
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98227-1215
Country	:	US
Telephone Number	:	360-734-9525
Fax Number	:	360-734-9505

Provider Business Practice Location Address
First Line	:	1810 BROADWAY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-3133
Country	:	US
Telephone Number	:	360-734-9525
Fax Number	:	360-734-9505

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. THERESA BLANCHE MURRY
Credential	:	D.C.
Telephone Number	:	360-734-9525

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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